an american expat living in the netherlands

Fertility The Back Story

February 14, 20177 comments

I have been mulling over sharing our story in blog format for a few months now. Primarily I was concerned with coming across as fishing for sympathy. Recently our new doctor recommended we move ahead with IVF. This comes with a lot of feelings. One of them is isolation. I desperately miss the support of our community in Portland. However, IVF was not exactly a viable option for us in the United States, so it’s a double edge sword really. That said, sharing my journey online helps me feel a little more connected to folks back home, and Piet and I decided together that it was something we felt fine about sharing. I will start with the back story, and then update you once I start the dreaded IVF meds next month.

In the Beginning…Our fertility story began in January 2015 . This is actually not a very long journey compared to others who have struggled to start a family for five or more years. I don’t actually know how long our journey will take, so there is no point in comparing.

After the initial six months of trying in Portland our GP recommended we have some preliminary tests done. I was hoping he would suggest this because deep down somehow I knew there was a problem, and in fact always felt as though having a baby was going to be a difficult road for us. Six months is not very long to try without results, but for our age range, it’s not a bad idea to get things checked out just in case. Now I’m going to use this moment to share some facts about infertility via a handy infographic. The point is, infertility can just as easily be on the man’s side, but there seems to be a general assumption that there is a problem with the woman. So if you’re having trouble getting pregnant, make sure to look into both sides. It’s also important to understand how common it can be for couples, and no amount of “just relaxing and giving it time” is going to help.

Diagnosis
So after some tests we were diagnosed with a fairly severe problem. I think most of the tests to diagnose infertility were covered partially by our insurance. My favorite exam was the HSG. Special fluid is injected into your uterus and fallopian tubes to balloon them up while a nurse or doctor takes x-rays of your insides! It was painful, but SCIENCE! I was on the other end taking iPhone pics of the screen which I can’t seem to find, otherwise I would add them to the post.

In addition to our primary fertility diagnosis, I had a polyp in my uterus that had basically been acting as an IUD for however long it existed. Luckily all that was needed was minor surgery to remove it. We had this done as soon as we were able, but even with our fairly good insurance, it ate up around 3-4k of our fertility / baby budget. Ouch! The news wouldn’t have been such a bummer if we didn’t have to enter the world of expensive fertility treatments next.

At this point it’s natural to start thinking things like “if nature doesn’t want us to have a family, then should we really try and force it?” or “If we can’t have a baby of our own, is it selfish to want one knowing that adoption is also an option?” Well excuse my French but, fuck that! If adoption or not pursuing a family at all is the right choice for you, it will become clear. If not at first, then at some point, you will know whats right for you. So don’t beat yourself up over the direction you decide to go. Getting an infertility diagnosis is said to cause just as much stress for some couples as a death. Ok, onward and forward…

Knowing how expensive any fertility treatments are in the U.S. (unless you somehow have that magical insurance that covers it), we started with a more natural recommendation from our GP. He had seen success in the past and it was worth a shot since it would be a lot cheaper if it worked. So we embarked on a three month regime of like 10 horse pill sized supplements a day. We were also advised that consistency was of utmost importance. The following three months we were so stressed about following the directions, worrying that missing a few pills here and there would ruin the whole thing, that our stress levels were through the roof. After all that, it didn’t help one bit. Such a breath of fresh air when our new antroposofisch GP here in Leiden explained to us why he doesn’t believe in supplements at all. But that is for a later date.

IUI
The next step was to try IUI’s (Intrauterine Insemination). It is both common practice in the U.S. and the Netherlands to try six sessions of IUI before considering the big guns – IVF. Regardless of the infertility cause, IUI always starts with a sperm “washing”. This basically means a sample is processed in a way that separates the good quality sperm from the bad ones. Then the good portion of the sample is injected directly into the uterus at the ideal time of ovulation. This means the little swimmers don’t have to swim nearly as far and have a better chance of making it to the egg before dying off. If you are interested, I recommend watching a little video about the journey sperm has to take to actually have a successful conception. Its a really harrowing journey and you will be surprised at how fascinating it is!

IUI is not typically covered by insurance, however we were at least able to claim some of the multiple blood tests and ultrasounds involved with each one. I think we paid around $800 out of pocket for the one IUI we did in Portland.

Surprise we are Moving!
After our first IUI we headed to Europe to visit family and do a little vacationing. As many of you know during that time Piet applied and interviewed for his current job in Amsterdam, and about four months later we found ourselves living in the Netherlands! Moving had been something we talked about from the very beginning. So for us we were taking steps to make our dream a reality. It also felt like the right time for us considering the monumentally better health care. A few similarities and differences from U.S. health care:

Basic health insurance is compulsory for all people who live or work in the Netherlands.

It is not totally free like in the U.K.

Dutch government is responsible for the accessibility and quality of the healthcare system in the Netherlands, but not in charge of it’s management. So there are still independent insurance companies for you to choose from, however the basic insurance is the same coverage across all insurers, as it is set by the government.

From an American perspective, basic Dutch insurance covers basically everything other than dental, alternative medicine, and physical therapy. If you get cancer, no problem, emergency c-section? Need some special in-home care? No problem…ambulance, blood tests, children up to 18 years are free, oh and did I mention mental health?…you get the idea.

The basic insurance plans are all around €100 a month. My plan includes dental, alternative care and extra bells and whistles for in case we do have a baby this year, and I pay around €160 a month.

There is an annual deductible of €385 which is fairly new and I hear some grumbles about from time to time, and I just laugh.

You have to get a referral from your GP to see any sort of specialist unlike in the U.S. but so far I haven’t really noticed any issues with waiting long periods of time to get an appointment.

As for fertility treatments, its 100% covered. We get six IUI and three rounds of IVF. Which by the way costs about $12,000 – $15,000 a pop in America.

Fertility Treatment in the Netherlands
About four months after our move I was granted my permanent residency here in the Netherlands. That meant I was able to apply for insurance and ask for a fertility referral from our GP. We met with a gynecologist who would be handling our treatment. We were so pleased to hear that we could start where we left off in Portland, with only a few additional blood tests that were missing from our paperwork.

We performed one IUI and were immediately recommended to move forward with IVF. And that was that. I think we were both prepared for the news, and I personally always had a feeling it would lead to IVF and was almost relieved not to have to spend the next 4 months doing more IUI’s. We are currently on track to start our first IVF cycle toward the middle of March.

IVF
While I am excited to be moving forward, I am also terrified. My plan is to blog about the experience and the insane injection schedule when we get into the process. But for now I will just give my version of what it will be like based on our consultation with our specialist and other blogs I have been reading.

Please note: When I say inject – I actually mean myself or Piet will be using real needles to give myself multiple shots every day. I think different hormones are meant to be given at different levels in the skin or muscle, so learning about your personalized schedule is very important. We won’t be doing that until March 10th.

Start: First you inject yourself with some hormones that shut down your bodies natural process, so a forced process can be induced with the daily injections.

The next 10-14 days: During a normal cycle, a women has multiple follicles in each ovary that are growing, ultimately one (sometimes two) end up maturing and thats the one that ovulates and can turn into a baby. With IVF, the goal is to force as many follicles to mature into viable eggs. Think about this: on a normal month, an ovary is about the size of an almond. During IVF I read that the ovaries can grow to the size of oranges. ORANGES!! So many women get very bloated and basically feel and even look pregnant during these two weeks.

In order to do all this, I will have to give myself multiple injections of different hormones every day. You also have to be your own chemist and combine multiple hormones them into one shot. I am NOT looking forward to injections, but I am sort of excited about documenting the process – because it makes me feel like a scientist.

Egg Retrieval: Once the eggs are mature enough, you go to the hospital to have them removed. There a doctor basically sticks a giant needle through the inside wall of your vagina and into each ovary. Then they use some special way of sucking the eggs out one by one.

The same day the eggs are fertilized in the lab, and then 3-5 days later after some of them have properly grown (we’re talking like 8 cells, so nothing even close to a human at this point), you come back and similar to an IUI, the embryo is placed in the uterus and all you can do it hope. The remaining embryos (if you have any) can be frozen and used the following months if you don’t have a successful pregnancy the first time.

I also found this super cool and pretty TedEd video about how IVF works online. I really recommend it!

SO that’s what the middle to end of March is going to look like for us.

I am neither feeling optimistic or pessimistic. I am just more or less blank about it. I think after the past two years of emotional ups and downs perhaps I feel shutting down hope is a way to protect myself. What I AM feeling is fear. Mostly fear of going through all of this and not having my friends and family in Portland there to talk to, support me, and bring me comfort food while unnatural amounts of hormones are flooding my system and my abdomen balloons our like a beach ball. It’s a double edge sword as I said before. Moving here allowed us to easily start the process and to have all the medical care we could hope for, yet we also have lost our community and support system which we really need.

Well, if you stuck through this entire post, then thank you. Now that the back story is out of the way, I hope to check back in March with some crazy posts about injections, maybe even a video! I know from experience that other women out there planning on doing, or currently doing IVF are Googling for stories from other women experiencing the same thing. So I hope this gives at least one other person some comfort out there!

Fertility The Back Story was last modified: February 14th, 2017 by Keven van Zoen

Can you feel my support from here!? I am supporting you SO HARD!! Love you. And I so want you two to be as happy as possible. I wish this wasn’t such a trial for you. I think your blog is fascinating and I’m proud of you for being so constructive through your experience.

Keven, you are awesome. “It was painful, but SCIENCE!” I wish you guys all the best on this journey! Thanks for being brave and sharing your story. Even though we’re not physically there with you, we are all with you 100%. Onward!!!